HIV Treatment Should Start Even Earlier, WHO Says

Women in Bangalore, India, make red ribbons at an HIV support center in November 2012.

Manjunath Kiran
/ AFP/Getty Images

Originally published on July 2, 2013 3:10 pm

Getting people on HIV drugs even before they get sick helps them live longer and slows the spread of virus, the World Health Organization said Sunday.

The number of new HIV infections has dropped by 20 percent worldwide since the push to expand HIV treatment worldwide began in 2002. The medications prevented about 4 million deaths from AIDS-related problems in developing countries, the WHO report says.

The impact of the antiretroviral drugs is so strong and positive that the WHO has even changed its recommendation for when to treating HIV. The new guidelines, released Sunday at an international AIDS conference in Malaysia, say that many more people should be on HIV drugs — up from 16.8 million to about 26 million, an increase of more than 50 percent.

Children under five and pregnant women should start medications immediately after they're diagnosed with HIV, the guidelines say. The same goes for anyone with an HIV-negative partner or spouse. For others, antiretroviral drugs should begin at the earliest signs of damage to the immune system.

Treating more people will, of course, cost more money – about $2.3 billion per year, or 10 percent more than the world currently spends on stopping HIV, according to the Associated Press.

Although it's unclear where this extra money will come from, the cost of the HIV drugs has been decreasing. Costs have declined by more than half since 2004, from about $1,000 per year for one person to $400 in 2011.

"These new treatment recommendations are ambitious, and needed; they're also feasible," Dr. Unni Karunakara, the president of Doctors Without Borders, said in a statement. "Now is not the time to be daunted, but to push forward with what we know works to get the best treatment possible to the most people, as soon as possible."

But other global health leaders don't think the new guidelines go far enough. The revision "gets most of the people we want on treatment, but not all," Michel Sidibe, who leads the United Nations AIDS agency, told The New York Times.

Providing even earlier treatment, he says, is critical for turning the tide on HIV. "What is holding us back is that we lack a vision for ending the epidemic," he said. "If we think we'll just manage it like a chronic disease for the next 50 years, we'll never get to the end."

The starting point for HIV treatment has been inching earlier and earlier over the past decade. In 2002, doctors waited until a person's CD4 T-cell count dropped below 200, or 200 cells per cubic millimeter of blood. In 2010, the limit rose to 350. And now, it's 500 – just at the bottom of the normal range.

CD4 T cells are a key component of the immune system; they are attacked by the HIV virus. When the number dips below 200, a person is officially diagnosed with AIDS and runs the risk of catching deadly infections.

Last year, scientists in the U.S. called for treating people as soon as they get diagnosed with HIV, regardless of their T-cell count.